The Model of Comprehensive Psychosocial Enhancement Practice

Following the Model of Comprehensive Psychosocial Enhancement Practice outlined in text, Case Management; Integrating Individual and Community Practice, this paper will present a hypothetical case management scenario. This paper will begin with an introduction to the fictitious client. This writer will play the role of a case manager and provide services to the client. A detailed report on the client served and the case management services will be presented and discussed in detail as if upon request of the supervisor. In addition the 15 functions of case management will be presented and applied to the hypothetical scenario of the fictitious client.

The Scenario

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I, the writer, am a case manager with the specific title of support and service coordinator at a domestic violence and sexual abuse support center and women’s shelter. As part of my job I perform the 15 functions of case management listed as follows: Access to the agency, Intake, Assessment, Goal setting, Intervention planning, Resource identification and indexing, Formal linkage to agencies and programs, Monitoring, Reassessment, Outcome evaluation, Interagency coordination, Counseling, Therapy, and Advocacy. Many of these functions I perform myself, while others are carried out by my coworkers or other agencies.

The Client

Dawn is a 49-year-old woman with two grown children. She has come to the shelter as a recovering alcoholic and domestic violence victim. She has been married for eight years her husband who has been violently abusive for over seven years. Dawn was brought to the domestic violence shelter through the local hospital, where she was being treated for injuries obtain through spousal physical abuse. Dawn’s arm was broken in three places after her husband beat her and threw her to the ground and stepped on and crushed her arm. This is the third time that Dawn has been to a support center in the past four years. The first function of case management being access to the agency is what brought Dawn to the shelter. Access to the agency was gained through working with and raising awareness of domestic violence in the local hospital, where staff is well informed on the center and posters are hung throughout the hospital in waiting areas.

Intake

Upon Dawn’s arrival to the support center I began with client intake. The first step in the intake process, identifying the client’s problem or situation was partially introduced by the nurse on call at the local hospital. Information received by myself from the nurse was limited to the injuries received, and the implied knowledge of Dawn’s injuries being a result of domestic violence. My first step was to speak with Dawn personally. I met with Dawn at the hospital.

Upon my arrival at the hospital I was directed to Dawn’s room. I introduced myself and explained that I was there because I received a report in the form of a phone call by hospital staff of suspected domestic violence. I told Dawn a little bit about my job and where I work, including some of the services we provide to domestic violence victims. Dawn admitted that her injuries were inflicted by her abusive husband. She stated that she has sought help in the past, and cannot go home.

Through the initial intake interview I was able to identify a need for emergency protection and shelter for Dawn. Dawn has two grown sons with whom she could not live because they are both living overseas. She has no family or friends in the area or in general for a support network due to her years of social confinement inflicted by her abusive husband. Dawn has no financial resources. However, Dawn is a licensed but not practicing Licensed Nurse’s Aid. In response to the information gathered in the initial intake I have offered Dawn shelter at the center, advocacy in obtaining a restraining order against her abusive husband, information on and help obtaining services such as medical coverage and food stamps, and the opportunity of intervention planning.

Assessment (Psychological, Social, and Medical)

Although Dawn has suffered a great deal over the past seven years including but not limited to physical and emotional abuse, and social confinement, she is of sound psychological standing. She is very aware and her thoughts are clear. She understands her situation and is prepared to overcome it. Dawn is due to years of constricted social contact, perhaps, slightly socially awkward. In my professional opinion, social therapy is not critical. However, the client could benefit from group therapy sessions for social interaction. Due to the specifics of Dawn’s broken arm she was advised by doctors and hospital staff that physical therapy is recommended and necessary for full recovery and use of her arm.

Goal Setting

Using the information collected during the initial intake and assessment process the client, Dawn, and I devised a plan for both long and short term goals. Dawn’s role as the client in the goal setting step included her personal perception of areas in need of improvement and her personal objectives. The objective of the support center is first and foremost the safety and well being of the client as a domestic violence victim. Dawn’s personal objectives coincided on this matter. In addition Dawn had objectives of staying out of the abusive relationship entirely and regaining an independent lifestyle. Dawn’s perception of areas in need of improvement was determined through both personal communication and the self-assessment form of the agency.

Dawn’s ultimate goal was to stay away from the abusive relationship with her husband from which she had previously sought help to escape, but continually returned. Her next goal is to regain and lead an independent lifestyle. In order to do this various sub-goals could be identified. These sub-goals include becoming financially independent; getting a job as an LNA, initially getting food stamps and possibly Temporary Aid for Needy Families, Medical coverage in the form of Medicaid until a later point where she may be covered through work or can afford coverage herself.

Intervention Planning

Dawn’s initial step in staying out of the abusive relationship will be to get a permanent restraining order in place against her husband. The initial temporary restraining order was obtain the first night Dawn spent in the hospital. An advocate from the support center will be available to go to the court with Dawn for her final hearing.

Dawn will be attending counseling services to minimize trauma of the abusive relationship that she endured. This will initially be one-on-one counseling, but group counseling was suggested as potentially beneficial for multiple reasons including social relations. Dawn agreed applying for food stamps and Medicaid would be a good first step toward financial independence from her husband. She plans to attend a job training program and will continue to live at the shelter until finding a job upon program completion.

Dawn is a recovering alcoholic and will be attending support meetings to remain sober. I have also informed Dawn of available programs, help and services in the area in regard to the issue of staying sober. I provided her with informational materials and tips on this subject.

Resource Identification and Indexing

Working with domestic violence victims on a daily basis, I as the case manager am faced with various needs and situations of clients. I have collected as much information as possible on services in the area and update this information often. I work in collaboration with other domestic violence programs and exchange agency and services information with colleagues. I have an electronic databank with updated information but also a paper version readily available for referencing. I have handouts from various organizations with whom this agency works with, and can supply the client with information in this form.

Formal Linkage, Counseling, and Therapy

As previously mentioned Dawn is in need of services in multiple areas. Some of the services can be directly provided through the support center, such as counseling, both individual and group, shelter and food, advocacy, and social interaction. Other services such as the job training and food stamps will be provided through the department of health and human services. She has individually chosen her sobriety support meetings based on information provided by the support center.

Dawn has been formally linked to medical care coverage through the Department of Health and Human Services. She has been linked with the local hospital for physical therapy and follow-up care for her arm. Transportation to doctor’s visits and therapy will be provided by either the shelter or the Department of Health and Human Services.

Informal Linkage

Dawn does not have a large existing social network. Her two grown sons are the only people with whom she has kept contact, even though this was minimal limited to birthdays and holidays, over the past seven years. In my opinion building a new social network is critical for Dawn. This is something she may begin achieving through meetings and interaction with other ladies in the shelter. Through my observations, I have come to the conclusion that Dawn is a bright, intelligent, and good natured woman. Once Dawn has the opportunity to participate in the job training program, and eventually finds employment she should have little trouble building her social network.

Advocacy, Monitoring, Reassessment, and Outcome Evaluation

As part of the advocacy program at the shelter we offer to help clients with and speak on their behalf with various agencies. The support center explains this and offers clients the opportunity to decide for themselves with which agencies we at the support center can communicate. Dawn agreed to all communication with all agencies. Dawn is staying at the shelter. Therefore it will be easier to effectively monitor her progress and assure that reassessment is done periodically. In general, I meet with clients to reassess their situation in a time frame anywhere from every month to every six months, or any time, either I or the client, believe this to be necessary. This also depends on the urgency and client’s needs. As for outcome evaluation, there has not been one done for this client. The reason for this is that the outcome evaluation is done upon termination. Dawn is in ongoing services through this agency. However, if she were terminating then an outcome evaluation would be done where we would determine any ongoing care needed.

Conclusion

Dawn was in care at a local hospital with multiple breaks to her arm, which she apparently could not explain in a believable fashion. Dawn came to the domestic violence support center through contact made by a nurse at the hospital. During intake and assessment I was able to gain insightful information on Dawn’s situation and needs. Together Dawn and I came up with a working list of goals, some of which have been reached in the short two month period that Dawn has been at the shelter and support center. Since she is a resident at the shelter monitoring progress and reassessment has been conducted in a timely fashion. Dawn is dedicated and working hard to obtain all her goals as independently as possible. I am pleased to inform that this has been a positive case management experience with no set-backs up to this point.